Social Determinants of Health

The purpose of Intermountain’s impact investing work is to Help People Live the Healthiest Lives Possible™ by supporting place-based initiatives that contribute to improved health and well-being. The place-based investing program accomplishes this by providing flexible capital to projects that address the social determinants of health within Intermountain Healthcare’s service area. This includes any location within a 200-mile radius of an Intermountain facility and encompasses Utah, Southern Nevada, and Southern Idaho. The social determinants of health are the conditions in which people are born, grow, live, work, and age that shape health. They include factors like health behaviors, socioeconomic status, and physical environment. Addressing these conditions is important for improving health and reducing longstanding disparities. Together, health behaviors, socioeconomic status, and physical environment are a greater driver of health outcomes and life expectancy than clinical health treatment.

Intermountain’s impact investing work is focusing on a few key social determinants: housing stability, employment, and financial wellness. These social determinants have been chosen based on independent research on needs in Utah and findings from Community Health Needs Assessments (CHNA). While investments that address any of the social determinants included in the graphic above may qualify, Intermountain is actively working to develop investing opportunities in these key areas.

Guiding Principles

Intermountain’s impact investing initiative is a part of Intermountain’s commitment to “move upstream” by addressing community and environmental factors that contribute to health. The following guiding principles were developed to align the impact investing work with Intermountain’s broader upstream strategy.

  • Impact one of our CHNA priority areas (improve mental well-being, prevent avoidable disease and injury, improve air quality)
  • Target improvements in the social determinants of health
  • Support local economic development
  • Target communities with low employment rates and low-income populations
  • Provide double-bottom-line returns as measured by financial and social impact metrics

Impact Measurement

This type of investment requires the ability to measure and report on the social impact created by an investment. Intermountain uses a framework developed by the Impact Management Project to evaluate the relative effects of potential initiatives and to select reporting metrics at the investment and portfolio level. The Impact Management Project’s framework relies on five dimensions of impact that can be applied to any investment opportunity:

  1. What. Identifies the outcomes the enterprise is contributing to and how important those outcomes are to stakeholders.
  2. Who. Identifies the stakeholders who are experiencing the outcome and how underserved they were prior to the enterprise’s effect.
  3. How Much. Identifies how many stakeholders experienced the outcome, what degree of change they experienced, and the length of time the outcome lasts.
  4. Contribution. Identifies whether an enterprise’s and investor’s efforts resulted in outcomes that were likely better than what would have occurred otherwise.
  5. Risk. Identifies the likelihood that impact will be different than expected.

Organizations receiving investments are required to report metrics. Intermountain then rolls up metrics at the portfolio level to understand total impact. To facilitate the collection of standardized, credible, and comparable impact data, Intermountain Healthcare utilizes the IRIS metrics developed by the Global Impact Investing Network in conjunction with the five dimensions of impact outlined above. These metrics are typically tied to a unit related to the specific social determinant of health addressed by the investment. Examples include number of affordable housing units built and number of jobs created. These metrics are chosen based on their research-based links to health outcomes.

Investment Strategy

Intermountain’s impact investing work can be categorized into two strategies. The first strategy is direct real estate lending. Direct lending allows for loan origination directly to qualifying organizations. This capability allows Intermountain to directly support highly-mission-aligned organizations and projects, effectively targeting very specific social impact outcomes. Available direct-loan products include acquisition and development, renovation, and semi-permanent financing for qualifying projects. Typically, these will be real estate loans secured by a lien position on real assets. Qualifying projects must address one or more social determinants of health and benefit a low- or moderate-income population living within Intermountain’s service area (Utah, Southern Nevada, Southern Idaho). Specific loan terms and requirements are outlined in the term sheet linked on this page.

The second strategy is intermediary investing, which involves debt or equity investments in funds, community development financial institutions (CDFIs), and other place-based investment vehicles that allow Intermountain to partner with organizations that are aligned with our mission. Intermountain Healthcare is actively pursuing opportunities to partner with local CDFIs, Community Development Corporation, and other mission-aligned partners on both on-balance sheet and off-balance sheet investments. This has been the primary strategy employed by other health systems in the Health Anchor Network who have developed place-based investing strategies. The goal of this strategy is to construct a portfolio that is diversified across asset classes (public/private debt, public/ private equity), across social determinants of health, and across geographies. This diversification helps to reduce the financial and impact risk of the portfolio while providing the flexibility to be responsive to local needs.

Projects that don’t meet all the specific outlined criteria for Intermountain’s direct loans, but are aligned with Intermountain’s mission, are encouraged to contact us. Intermountain values innovation and would like to support mission-aligned efforts.

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Investment Example 1: Utah Housing Preservation Fund

The Utah Housing Preservation Fund exists to preserve the current affordable housing stock in Utah. The Fund accomplishes this by purchasing affordable housing that is at risk of transitioning to market rate, conducting rehabilitation to ensure housing is safe and healthy, and operating the properties at rates affordable to Utahns living at less than 80% of the Area Median Income. The fund's first acquisition is a portfolio of duplexes scattered across Salt Lake County, purchased from Housing Connect (the housing authority of Salt Lake County). The duplexes offer a unique opportunity for the Fund to preserve the affordability of large multi-bedroom units that are critical for large families. These units will be available primarily to Housing Choice voucher recipients living at less than 30% of Area Median Income.

This initial acquisition will not only preserve affordable housing for existing residents, but also allow Housing Connect to reinvest the proceeds of the purchase to further stabilize their public housing portfolio and generate more than 100 additional units serving low-income households. 

Intermountain’s participation in this purchase is atypical. These loan terms were necessary because of the nature of the properties and the Area Median Income served. Intermountain is grateful for the opportunity to serve such a high needs population and to help preserve such a scarce resource in the Utah affordable housing market.

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Investment Example 2: Community Capital Management

Community Capital Management is an impact investing firm that focuses on delivering superior risk-adjusted returns through investment strategies that contribute to positive environmental and social outcomes. One of their products, a mutual find with ticker symbol CRANX, allows investors to identify geographies or impact priorities to direct the investment of their funds. Most of the fund is invested in Agency MBS, Agency CMBS, and Taxable Municipal Bonds.

With Intermountain’s investment in CRANX, Community Capital Management is providing a valuable source of liquidity for mortgage originators in Utah who fund projects that address social and environmental needs. Transit-oriented development, affordable housing, rural community development, healthy communities, and environmental sustainability are all examples of the impact themes that Community Capital Management seeks when purchasing mortgage backed securities from Utah lenders.

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Investment Example 3: First Step House

First Step House’s mission is to help people build lives of purpose, meaning, and recovery. Launched in 2017, the REACH (Recovery, Engagement, Assessment, Career, and Housing) program utilizes evidence-based and comprehensive behavioral health treatment, housing support, and case management services. The program helps participants gain employment, housing, and wellness to establish long-term stability in the community. Intermountain partnered with First Step House to provide a semi-permanent loan, which supported the expansion of the REACH program from 23 to 60 beds though the purchase and rehabilitation of a new residential treatment facility.